Methods

In selecting material for this article, I used the current publications section of the journal Sexually Transmitted Infections (formerly Genitourinary Medicine) and searched Medline under the following headings: Chlamydia trachomatis, human papillomavirus, genital herpes, famciclovir, and valaciclovir.

Epidemiological changes

Rates of infection with gonorrhoea in England had been declining rapidly, even before the government launched its Health of the Nation initiative in 1992.2 Unfortunately, soon after the target (a fall in gonorrhoea rates of at least 20% by 1995) had been reached, the trend was reversed: diagnoses of gonorrhoea in genitourinary medicine clinics rose by 20% between 1995 and 1996.1 Over the same period, diagnoses of genital infection with C trachomatis rose by 11% and those of genital warts by 5%.1 Among homosexual men, there was a steady increase in the incidence of genital warts between 1990 and 1995, while there was no clear trend in the incidence of gonorrhoea (fig 1).

Recent advances

Amplification assays, such as the ligase chain reaction, have excellent sensitivity and specificity

A third class of anti-retroviral drug is now available—the non-nucleoside reverse transcriptase inhibitors, such as nevirapine

Valaciclovir and famciclovir offer more convenient dosage regimens than aciclovir

A single dose regimen of azithromycin has a place in treating Chlamydia trachomatis, especially where compliance may be a problem